Halitosis - Management

Management

Chronic halitosis is not well understood by most physicians and dentists, so effective treatment is not always easy to find. The following strategies may be suggested:

1. Gently cleaning the tongue surface twice daily is the most effective way to keep bad breath in control; that can be achieved using a tooth brush, tongue cleaner or tongue brush/scraper to wipe off the bacterial biofilm, debris, and mucus. An inverted teaspoon may also do the job. Scraping or otherwise damaging the tongue should be avoided, and scraping of the V-shaped row of taste buds found at the extreme back of the tongue should also be avoided. Brushing a small amount of antibacterial mouth rinse or tongue gel onto the tongue surface will further inhibit bacterial action.
2. Eating a healthy breakfast with rough foods helps clean the very back of the tongue.
3. Chewing gum: Since dry-mouth can increase bacterial buildup and cause or worsen bad breath, chewing sugarless gum can help with the production of saliva, and thereby help to reduce bad breath. Chewing may help particularly when the mouth is dry, or when one cannot perform oral hygiene procedures after meals (especially those meals rich in protein). This aids in provision of saliva, which washes away oral bacteria, has antibacterial properties and promotes mechanical activity which helps cleanse the mouth. Some chewing gums contain special anti-odor ingredients. Chewing on fennel seeds, cinnamon sticks, mastic gum, or fresh parsley are common folk remedies.
4. Gargling right before bedtime with an effective mouthwash (see below). Several types of commercial mouthwashes have been shown to reduce malodor for hours in peer-reviewed scientific studies. Mouthwashes may contain active ingredients that are inactivated by the soap present in most toothpastes. Thus it is recommended to refrain from using mouthwash directly after toothbrushing with paste (also see mouthwashes, below).
5. Maintaining proper oral hygiene, including daily tongue cleaning, brushing, flossing, and periodic visits to dentists and hygienists. Flossing is particularly important in removing rotting food debris and bacterial plaque from between the teeth, especially at the gumline. Dentures should be properly cleaned and soaked overnight in antibacterial solution (unless otherwise advised by your dentist).
6. Probiotic treatments, specifically Streptococcus salivarius K12 has been claimed to suppress malodorous bacteria growth, however well designed randomised control clinical trails are needed to assess this. Certainly there is more evidence for mechanical tongue cleansing and to a lesser extent specific antimicrobial mouthwashes.